Citation Nr: 20008087 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 14-09 167 DATE: January 30, 2020 ORDER Entitlement to an increased rating in excess of 10 percent for service-connected degenerative disc disease of the thoracolumbar spine is denied. Entitlement to an increase rating in excess of 10 percent for service-connected residuals of an avulsion fracture at the medial malleolus of the left ankle is denied. Entitlement to an increased rating in excess of 10 percent for service-connected degenerative joint disease of the left knee is denied. FINDINGS OF FACT 1. At no point during the period on appeal has the Veteran’s thoracolumbar spine manifested in forward flexion limited to 60 degrees, combined range of motion limited to 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. At no point during the period on appeal has the Veteran’s left ankle manifested in a marked limitation of range of motion. 3. At no point during the period on appeal has the Veteran’s left knee manifested in a limitation of flexion of 30 degrees or less. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for service-connected degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5243. 2. The criteria for a rating in excess of 10 percent for service-connected residuals of an avulsion fracture at the medial malleolus of the left ankle have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5271. 3. The criteria for a rating in excess of 10 percent for service-connected limitation of flexion of the left knee have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from July 1998 to July 2002, and then served on active in the United States Army from April 2003 to August 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a January 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. By way of background, the Veteran was initially awarded service connection for arthritis of the thoracolumbar spine with degenerative disc disease, arthritis of the left knee with degenerative joint disease, and residuals of a fractured left ankle, i.e.: all issues on appeal, pursuant to an October 2009 rating decision. From this rating decision, all issues above were assigned respective initial ratings of 10 percent since August 24, 2009. The Veteran did not express any disagreement with the propriety of these initial ratings within one year of the rating decision; therefore, the initial rating decision is final with respect to these issues. The Veteran then filed an application for increased ratings for the issues on appeal on September 15, 2011. From this application for increased ratings, the rating decision on appeal was issued in January 2012, and the Veteran perfected his appeal with a valid VA Form 9 in March 2014. In August 2018, the Board remanded the Veteran’s claims on all issues on appeal, so that the Veteran could be afforded updated examinations. These examinations were performed in April 2019. The Board finds that the examinations for the spine, left ankle, and left knee are in substantial compliance with the remand directives from the August 2018 Board decision. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating 1. Entitlement to a rating in excess of 10 percent for service-connected degenerative disc disease of the thoracolumbar spine is denied. The Veteran is service-connected for degenerative arthritis of the thoracolumbar spine with degenerative disc disease, which is currently evaluated as 10 percent disabling, under 38 C.F.R. § 4.71a. He filed a claim for an increased rating on September 15, 2011, alleging that same had increased in severity, thereby warranting an increased evaluation. Upon consideration of the evidence of record and the relevant laws and regulations, the Board finds that higher ratings are not warranted at any point pertinent to the appeal. At a December 2011 VA examination, the Veteran reported constant pain, and a limitation of activities. Indeed, the Veteran reported flare-ups approximately once to twice weekly. The Veteran reported that he could not stand up during flare-ups and that the flare-ups last a majority of the day. Upon physical examination, ranges of motion testing revealed forward flexion to 5 degrees, with objective evidence of painful motion beginning at 5 degrees; extension to 5 degrees, with objective evidence of painful motion beginning at 5 degrees; left and right lateral flexion to 5 degrees, with objective evidence of painful motion beginning at 5 degrees; left and right lateral rotation to 5 degrees, with objective evidence of painful motion beginning at 5 degrees. The Veteran was able to perform repetitive-use testing with at least three repetitions. The Veteran did not have any additional limitation in range of motion following repetitive-use testing. The examiner noted that it was unclear if the Veteran was fully participating with range of motion testing, because such a decreased range of motion was atypical. Functional loss was noted to consist of less movement than normal and painful movement. The Veteran had localized tenderness or pain to palpation for joints of the thoracolumbar spine. The examiner noted that the Veteran’s guarding or muscle spasms both resulted in abnormal gait, and were not severe enough to result in abnormal gait or spinal contour. Muscle strength testing revealed active movement against gravity in the great toes. There was no muscle atrophy. Deep tendon reflexes were normal. Sensory examination was decreased in the right upper thigh, right thigh/knee, right lower leg/ankle, and right foot/toes. The Veteran did not have radicular pain, or any other signs of radiculopathy. There was no ankylosis or other neurologic abnormalities related to the Veteran’s back disability. The Veteran did not have intervertebral disc syndrome. In a September 2014 examination, the Veteran’s diagnosis of degenerative arthritis of the spine as of 2009 was confirmed and the Veteran reiterated the presence of flare-ups. Ranges of motion were measured as follows: forward flexion to 90 degrees or greater, with objective evidence of painful motion beginning at 90 degrees or greater; extension to 30 degrees or greater, with objective evidence of painful motion beginning at 30 degrees or greater; left and right lateral flexion to 30 degrees or greater, with objective evidence of painful motion beginning at 30 degrees or greater; left and right lateral rotation to 30 degree or greater, with objective evidence of painful motion beginning at 30 degrees or greater. The Veteran did not have any additional limitation in range of motion following repetitive-use testing. Functional loss was noted to consist of painful movement, disturbance of locomotion, and interference with sitting, standing, and/or weight-bearing. The Veteran had localized tenderness or pain to palpation for joints of the thoracolumbar spine. The Veteran did not have had guarding or muscle spasm that resulted in abnormal gait or abnormal spinal contour. Muscle strength testing was normal. There was no muscle atrophy. Deep tendon reflex examination and sensory examination was normal. The Veteran had constant moderate radicular pain in the right and left lower extremities, and moderate paresthesias and/or dysesthesias and numbness in the right and left lower extremities. The examiner found that the Veteran had mildly severe radiculopathy in the sciatic nerve. There were no other signs of radiculopathy. There was no ankylosis, or other neurologic abnormalities. The Veteran had IVDS but had not had any incapacitating episodes over the past 12 months. Additionally, this examination notes that the Veteran regularly used a cane as an assistive device in locomotion. The examiner found that the Veteran’s back condition impacted his ability to work. Specifically, that the Veteran’s back disability limits walking and standing, with an inability to get out of bed some days, and no lifting or bending. In a June 2017 examination, the Veteran’s diagnosis of degenerative arthritis of the spine was confirmed and noted a 2013 diagnosis of bilateral lower extremity radiculopathy. The Veteran also reiterated the presence of flare-ups. Ranges of motion were measured as follows: forward flexion to 80 degrees; extension to 20 degrees; left and right lateral flexion to 30 degrees; left and right lateral rotation to 30 degrees. Pain was noted during flexion and extension but did not result in functional loss. The Veteran was able to perform repetitive use testing, no additional loss of function or range of motion after three repetitions was observed. With respect to flare-ups, the examiner was “unable to say without mere speculation” that pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups. The Veteran had muscle spasm that did not result in abnormal gait or abnormal spinal contour. He did not have any guarding. Muscle strength, reflex examination, and sensory examination were all normal. The Veteran had intermittent mild radicular pain in his bilateral lower extremity, and mild paresthesias and/or dysesthesias in his bilateral lower extremities. The examiner indicate that the Veteran’s sciatic radiculopathy was mild in severity. There was no ankylosis, and the Veteran had no other neurologic abnormalities. The examiner noted that the Veteran did not have IVDS and did not use an assistive device. The examiner found that the Veteran’s back condition impacted his ability to work. Specifically, that the Veteran has difficulty with prolonged sitting. Finally, the examiner noted that it was not feasible to test passive range of motion of the thoracolumbar spine. However, that since the Veteran reported pain in the lumbar spine during seated physical examination, that there was pain in non-weightbearing. In an August 2018 remand, the Board noted insufficiencies regarding the above examinations. Specifically, that the Board could not reconcile the findings of the September 2014 VA examination and June 2017 VA examination. In that regard the June 2014 VA examination found that the Veteran had IVDS and used a cane, whereas the June 2017 VA examination found that the Veteran did not have IVDS and did not use a cane. After the August 2018 Board remand, the Veteran underwent another VA examination of the spine in April 2019. Upon physical examination, ranges of motion were measured as follows: forward flexion to 80 degrees; extension to 25 degrees; left and right lateral flexion to 30 degrees; left and right lateral rotation to 30 degrees. Pain was noted during flexion and extension but did not result in functional loss. There was objective evidence of mildly severe localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. The Veteran was able to perform repetitive use testing, no additional loss of function or range of motion after three repetitions was observed. The examiner noted that the Veteran’s range of motion of the thoracolumbar spine could be affected by pain, fatigue, and lack of endurance, as caused by repeated use over time. The examiner indicated that forward flexion was limited to 70 degrees; extension to 20 degrees; left and right lateral flexion to 20 degrees; left and right lateral rotation to 20 degrees. While the examination was not conducted during a flare-up, the examiner was able to determines the functional loss caused by a flare-up. In that regard, the examiner estimated that the Veteran’s range of motion would be as follows: forward flexion was limited to 70 degrees; extension to 20 degrees; left and right lateral flexion to 20 degrees; left and right lateral rotation to 20 degrees. There was no guarding or muscle spasms. Muscle strength, reflex examination, and sensory examination was normal. The Veteran had constant moderate radicular pain in his bilateral lower extremity, moderate paresthesias and/or dysesthesias in his bilateral lower extremities, and moderate numbness. The examiner found that the severity of the Veteran’s radiculopathy was mild in the sciatic nerve. There was no ankylosis or other neurologic abnormalities. The examiner found that the Veteran did not have IVDS, but that he did occasionally use a brace as an assistive device. In that regard, the examiner stated that the Veteran may wear a back brace when his back-pain flares-up. Finally, the examiner denied objective evidence of pain in non-weight bearing testing and confirmed that the Veteran’s passive range of motion is the same of his active range of motion. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). As compared to the above, pre-remand examinations, this April 2019 examination is compliant with Sharp and Correia, is otherwise compliant with the Board’s remand directives, and is adequate to the extent that all conclusions are supported by scientific rationale. Accordingly, this examination is entitled to significant probative weight. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities. A review of the treatment notes does not show findings worse that contemplated by the VA examiners. The above ranges of motion suggest that the Veteran is not entitled to a rating more than 10 percent for his lumbar back disability. Additionally, the Veteran did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Moreover, the Veteran has not been diagnosed with ankylosis anywhere in his spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the preponderance of the evidence reflects that the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board acknowledges that a September 2014 VA examiner noted that the Veteran had IVDS, however, he has never been prescribed bedrest during the pendency of this appeal. Indeed, at that time, the examiner found that the Veteran did not have any incapacitating episode over the past 12 months due to IVDS. Regardless, the preponderance of the evidence of record precludes a finding that the Veteran’s thoracolumbar spine is entitled to a rating in excess of 10 percent at any time on appeal In reaching these conclusions, the Board has also considered the Veteran’s statements that he is entitled to higher ratings for his thoracolumbar spine disability. In this case, the Board finds that the Veteran is competent to report his experiences of pain, numbness, tingling, and any limitations that he observed through his senses. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a)(2). The Board acknowledges the Veteran’s belief that his symptoms are of such severity as to warrant higher ratings; however, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability is evaluated, more probative than the Veteran’s assessment of the severity of his disabilities. Regarding neurological impairment, the Veteran has already been granted service connection for bilateral lower extremity radiculopathy in the sciatic nerve and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. In sum, the Board finds that the claim for an increased rating in excess of 10 percent for the Veteran’s service-connected thoracolumbar spine disability must be denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine in attempting to resolve any reasonable doubt in favor of the Veteran; however, for the reasons articulated above, the rule does not apply with respect to the claim for an increased rating for the thoracolumbar spine. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to a rating in excess of 10 percent for service-connected residuals of an avulsion fracture at the medial malleolus of the left ankle since is denied. As indicated earlier, the Veteran was assigned an initial rating of 10 percent for his service-connected left ankle disability, effective August 24, 2009. The Veteran now seeks an increased rating, pursuant to his September 15, 2011 claim for additional benefits. This left ankle disability is currently rated under Diagnostic Code 5271. Under Diagnostic Code 5271, a rating of 10 percent is warranted when limitation of motion of the ankle is moderate. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. The maximum rating of 20 percent disabling is available under Diagnostic Code 5271 where the limitation of motion in the ankle is marked. Id. Normal ankle motion is dorsiflexion to 20 degrees, and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II. According to MERRIAM WEBSTER, “moderate” means “tending toward the mean or average amount or dimension”. See www.merriam-webster.com/dictionary/moderate. “Marked” means “having a distinctive or emphasized character”. See www.merriam-webster.com/dictionary/marked. Upon consideration of the evidence of record and the relevant laws and regulations, the Board finds that a rating in excess of 10 percent is not warranted at any point pertinent to the appeal. At a December 2011 examination, the Veteran reported flare-ups of the left ankle, which makes it “difficult trying to get around, do normal things.” Plantar flexion and dorsiflexion each ended at 5 degrees, where objective evidence of painful motion respectively began. While the Veteran was able to perform repetitive use testing after three repetitions, no loss of range of motion was observed; however, functional loss was reported by virtue of localized tenderness. Finally, ankylosis was denied. There were no other pertinent findings, complications, conditions, signs and/or symptoms related to his ankle disability. The examiner noted that the Veteran’s ankle impacted his ability to work. However, the examiner noted that the Veteran appeared to exhibit symptoms not consistent with any orthopedic diagnosis. Specifically, that such limited range of motion is atypical and that there was no apparent cause for the demonstrated weakness or decreased range of motion. In a June 2017 examination, the Veteran specifically denied flare-ups of the left ankle, but characterized his ankle trouble as “minor, primarily when it is cold outside.” Similarly, he denied functional loss or impairment of the left ankle. The examination yielded mostly unremarkable results: “all normal” ranges of motion (plantar flexion to 45 degrees, and dorsiflexion to 20 degrees), no pain, no evidence of pain with weight bearing, no additional loss of function or range of motion after successful repetitive use testing, no significant limitations of functional ability with repeated use over a period of time due to pain, weakness, fatigability, or incoordination, and no ankylosis. However, the Veteran did have mild tenderness to the medial malleolus. Further, ankle instability was suspected. Finally, the Veteran was afforded a VA examination for the left ankle disability in April 2019. In compliance with the August 2018 Board remand directives, this examination addresses flare-ups of the Veteran’s ankle, as well as the difference between active and passive ranges of motion—both weight bearing and non-weight bearing. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017); Correia v. McDonald, 28 Vet. App. 158, 168 (2016). This examination is assigned significant probative weight, as it is fully compliant with Sharp and Correia, and is otherwise consistent with the remand directives from August 2018. On range of motion testing, left ankle plantar flexion ended at 45 degrees and dorsiflexion ended at 20 degrees—all normal. No pain was noted on the examination; however, “minimal” localized tenderness was noted on the left medial malleolus distal aspect of the soft tissue. There was no additional limitation in range of motion following repetitive use testing in the Veteran’s ankle. Over time, the examiner noted functional loss caused by pain and lack of endurance, but this was not estimated to have any further loss of range of motion. Further the examiner noted that pain and lack of endurance significantly limit functional ability with flare-ups; however, the examiner noted that there was no loss of range of motion during a flare-up. Full muscle strength was noted in the both ankles, with no atrophy. The Veteran’s limitations appear to be limited to “occasional” use of a brace during a flare-up, and difficulty manipulating the clutch of a manual transmission automobile during a flare-up. Finally, with respect to Correia criteria, the examiner failed to find objective evidence of pain on non-weight bearing motion, and passive range of motion was the same as active range of motion. A review of the record shows that the Veteran also receives treatment for various disabilities at the VA Medical Center. However, there is no indication from the treatment notes of record that the Veteran has symptoms of his ankle disability that are worse than those already reported by the VA examiners. The Board acknowledges that the Veteran’s December 2011 VA examination indicated that the Veteran’s plantar flexion and dorsiflexion each ended at 5 degrees, where objective evidence of painful motion respectively began. However, at that time, the examiner indicated that limited range of motion is atypical and that there was no apparent cause for the demonstrated weakness or decreased range of motion. Further, at the June 2017 and April 2019 VA examinations, the Veteran’s range of motion on examination demonstrated plantar flexion to 45 or greater, and dorsiflexion to 20 degrees without pain. Thus, the Board finds that such range of motion does not constitute loss of motion that more nearly approximates marked limitation of motion. The Board has considered all of the lay and medical evidence and finds that the weight of the evidence is against the assignment of a disability rating in excess of 10 percent for the left ankle. The Board accepts that the Veteran experiences pain in certain circumstances such as prolonged walking, standing, or repetitive use of stairs. The Board also accepts the VA examiner’s assessment of functional loss including weakened movement, excess fatigability, disturbance of locomotion, interference with sitting, standing and weight-bearing—as specifically manifesting in cold weather and additional interference in driving. However, the Veteran’s currently-assigned 10 percent disability rating already accounts for such pain and functional loss. In this regard, his current limitation of motion would normally be noncompensable but the agency of original jurisdiction assigned an initial 10 percent disability rating for the Veteran’s painful motion. Neither the lay nor medical evidence reflects the functional equivalent of symptoms required for a higher evaluation. In order to warrant a higher evaluation, there must be the functional equivalent of marked limitation of motion of the ankle, and such is not shown by the record. The Board has considered whether a higher or separate disability rating is available under any other potentially applicable provision of the rating schedule. However, neither a higher nor separate evaluation is warranted based on any other provision of the rating schedule as there is no ankylosis or malunion of the os calcis or astragalus. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5273. For these reasons, the Board is constrained to find that the preponderance of the evidence is against a rating in excess of 10 percent for the left ankle. 3. Entitlement to a rating in excess of 10 percent for service-connected limitation of flexion of the left knee since August 24, 2009 is denied. The Veteran has asserted that he is entitled to higher ratings for his left knee disability as his symptoms are worse than those contemplated by the currently assigned ratings. The Veteran was first afforded a VA examination in December 2011. The Veteran reported flare-up, stating that he “can’t get around.” At that examination, the examiner found no instability. During examination, the Veteran’s left knee flexion ended at 45 degrees, and his left knee extension ended at 0 degrees. The examiner noted that the repetitive movements did not reveal a decrease range of motion. The examiner noted that the Veteran had functional loss after repetitive-use testing. Specifically, that the Veteran had less movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. No knee instability, patellar subluxation, other tibial or fibular impairments, meniscal conditions, nor scars were noted. Importantly, the examiner noted that the Veteran appears to exhibit symptoms not necessarily consistent with any orthopedic diagnosis. In that regard, the examiner stated that the Veteran’s limited range of motion is very atypical, and that there is no apparent cause for the demonstrated weakness or decreased range of motion. The Veteran was afforded another VA examination in September 2014. The Veteran continued to assert flare-ups, claiming “trouble with mobility, trouble bending, with stairs, trouble with walking and sitting and changing positions, knees give out sometimes causing problems showering.” Upon physical examination, the Veteran’s left knee flexion ended at 130 degrees, and extension ended at 0 degrees. The Veteran had identical ranges of motion after repetitive use testing. The examiner noted that the Veteran had additional functional loss. Specifically, that the Veteran had less movement than normal, pain, swelling, instability of station, disturbance of locomotion, and interference with sitting, and pain. Joint stability tests were normal. Further, there was no patellar subluxation, meniscal conditions, joint replacements, nor scars. However, the Veteran claimed to have suffered from a stress fracture of the left leg. The examiner found that the Veteran’s knee condition impacted his ability to work. In that regard, the Veteran had trouble with prolonged sitting, standing, walking, bending, stooping, stairs, and crawling. The Veteran was afforded another VA examination in June 2017. The Veteran characterized his flare-ups as causing “difficulty with prolonged walking, avoids sports.” Left knee flexion was observed to end at 130 degrees, but extension ended at 0 degrees. In this examination, in addition to identical ranges of motion after repetitive use testing, no functional loss was observed. No ankylosis was noted. Further, there was no history of recurrent subluxation or lateral instability, knee instability, other tibial or fibular impairments, meniscus condition, nor other pertinent physical findings or scars. Again, the examiner indicated that the Veteran’s knee impacted his ability to perform occupational tasks. Specifically, that the Veteran had difficulty climbing in and out of the truck and operating the clutch. Finally, the examiner noted that there was no change in range of motion when tested passively. That the Veteran reported having pain during passive range of motion, which signified pain when the joint was used in non-weightbearing. Finally, the Veteran was afforded a VA examination for the left knee disability in April 2019. In compliance with the August 2018 Board remand directives, this examination addresses flare-ups of the Veteran’s knee, as well as the difference between active and passive ranges of motion—both weight bearing and non-weight bearing. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017); Correia v. McDonald, 28 Vet. App. 158, 168 (2016). This examination is assigned significant probative weight, as it is fully compliant with Sharp and Correia, and is otherwise consistent with the remand directives from August 2018. The Veteran’s left knee was confirmed as diagnosed with osteoarthritis as of 2004, Symptoms were said to include “pain, stiffness, and occasional locking of knee.” Range of motion results were as follows: flexion ended at 120 degrees and extension ended at 0 degrees. Pain was noted on extension, but did not cause functional loss. There was pain with weight bearing, and there was objective evidence of crepitus. There was no additional loss of function or range of motion after three repetitions, but pain, fatigue, and lack of endurance were estimated to limit left knee flexion to 110 degrees after repetitive use over time, and during flare-ups. The left knee did not exhibit a loss of strength, atrophy, ankylosis, instability of any kind, nor meniscal conditions. There was no objective evidence of pain on non-weight bearing, the Veteran passive range of motion was the same as active range of motion, and there was no objective evidence of pain on passive range of motion testing. The Veteran does receive treatment at the VA Medical Center for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has left knee impairment that is worse than that reported in his various statements and the VA examination reports of record, to specifically include additional findings of limitation of motion. For the entire appeal period, the Board has carefully reviewed and considered the Veteran’s statements regarding the severity of his left knee disability. The Board acknowledges that the Veteran, in advancing this appeal, believed that the disability on appeal was more severe than the previously assigned 10 percent disability rating reflected. Moreover, the Veteran is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, with respect to the requirements for higher ratings, the competent medical evidence offering detailed, specific, specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal; the medical evidence also largely contemplates the Veteran’s descriptions of symptoms. The lay statements have been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). A rating is not warranted under DC 5261 for limitation of extension. December 2011, September 2014, June 2017, and April 2019 VA examinations determined that there was no limitation of extension. Additionally, VA medical records indicate that the Veteran's extension was not limited. Accordingly, a rating under DC 5261, limitation of extension, is not warranted. The Board acknowledges that the April 2019 examination reflects pain on extension. However, at that same examination, the Veteran’s pain was found to not cause functional loss. Indeed, the preponderance of the evidence does not reflect that the Veteran’s pain on extension has caused any functional impairment during the period on appeal. A rating is not warranted under DC 5257 for recurrent subluxation or lateral instability. At no time during the appeal period was objective evidence found of instability or subluxation. December 2011, September 2014, June 2017 VA, and April 2019 examinations did not reveal lateral instability or recurrent subluxation as joint stability testing results were within normal limits. VA treatment records also do not establish subluxation or lateral instability. While the Veteran has indicated subjective complaints of joint instability, the preponderance of the evidence indicates that the Veteran did not have joint instability during the appeal period. A rating is not warranted under DC 5258, dislocated semilunar cartilage, and DC 5259, removal of semilunar cartilage. Examinations and treatment records do not reveal dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion. Further, there is no medical evidence indicating that there was symptomatic removal of the semilunar cartilage. Finally, separate, compensable disability ratings for the left knee are not warranted under DC 5256 for ankylosis, DC 5262 for impairment of the tibia and fibula, DC 5263 for genu recurvatum, or DC 7804 for unstable or painful scars. There is no evidence demonstrating ankylosis, genu recurvatum, impairment of the tibia or fibula, or unstable or painful scar of the left knee. As the preponderance of the evidence is against a finding that the Veteran’s disability more nearly approximates the criteria for a higher rating, or a rating under additional diagnostic codes, the claim must be denied. 38 C.F.R. §§ 4.3, 4.7. Irvin Cannaday Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael B. Engle, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.